Body dysmorphic disorder

Body dysmorphic disorder (BDD), sometimes called body dysmorphia, is a type of obsessive-compulsive disorder. People with BDD have a preoccupation with some aspect of their appearance (that nobody else may notice), which distracts them so much that they often can’t go about their normal daily activities.

Muscle dysmorphia is a form of BDD. People with muscle dysmorphia think their muscles are too small, even if they’re quite muscular. They might have obsessive dietary and exercise behaviours that dominate their day-to-day lives.

BDD affects around 1 in 50 adults. It usually begins during the teenage years and gradually gets more severe.

BDD is just as common in males as in females, although muscle dysmorphia usually only occurs in males.

Lots of people with BDD don’t realise they have it.

Common behaviours of people with BDD include:

• Spending hours each day grooming
• Picking at their skin or repeatedly touching the part of their body they are concerned about
• Constantly checking their appearance in a mirror, amounting to hours spent each day, or avoiding mirrors altogether
• Seeking reassurance about their appearance from other people
• Trying to hide the part of their body they are concerned about, with things like makeup, clothing or their hair
• Excessive exercise
• Comparing their appearance with others
• Seeking help to change the appearance of the part of their body they are concerned about, for example, through cosmetic surgery.

We don’t fully understand why some people get BDD and some don’t, but genetic, psychological and social factors probably all contribute.

BDD is more likely than usual to occur in people who have a mother, father, sister or brother with the disorder, who have experienced childhood trauma, or who are from minority groups.

Most people with BDD don’t get diagnosed, often because they don’t realise they have a problem.

BDD is a psychological diagnosis based on the following criteria:

1. Constantly thinking or being concerned about one or more problems with your appearance, which are not noticed by other people
2. Repetitive behaviours or thoughts related to the concerns about your appearance (e.g. skin picking, comparing your appearance to others)
3. Being distressed by your appearance or being unable to go about normal activities (e.g. work, social activities)
4. Having an eating disorder that can’t be explained by concerns about weight or body fat.

The behaviours associated with BDD can be reduced by seeing a psychologist or psychiatrist for cognitive behavioural therapy, sometimes in combination with medication.

Getting cosmetic treatment for the part of your body that worries you will most likely not relieve your concerns.

BDD can last your whole life, and the psychological effects it has during your teenage years can have lasting consequences for how you think and act.

Males with BDD are more likely than normal to have anxiety, depression, emotional and behavioural problems, relationship troubles, hyperactivity and low quality of life. When these problems occur during your teenage years, they can have long-term consequences for your social, romantic, educational and working life.

If you answer yes to most or all the questions below, you should talk to your doctor.

• Are you concerned about some aspect of your appearance?
• Do you spend a lot of time worrying about some aspect of your appearance?
• Do you spend a lot of time trying to hide physical defects?
• Do you think you are malformed, misshapen or disfigured in some way?
• Do you think your body functions in an offensive way (e.g. bad body odour, flatulence, sweating)?
• Has anyone told you that you look normal, even though you know something is wrong about your appearance?
• Have you felt like you need to see a medical specialist (e.g. cosmetic surgeon, dermatologist) to correct a problem with your appearance?
• Do you feel the need to change your appearance in photos by using apps (like Facetune) or filters (like in Snapchat)?

Listen to the people who are close to you if they tell you they are concerned about you. It might be worth seeing a doctor to rule out the condition, rather than living with a problem you can’t see, that could be treated.